Abstract Introduction Hemoptysis in pregnancy is extremely rare and can present as life-threatening hemoptysis1. We report a rare case of hemoptysis in pregnancy due to a bronchial Dieulafoy lesion, which was treated with elective cesarean section, bronchoscopy and bronchial artery embolization. Case Presentation A 32-year-old primigravid woman with a history of hypertension, Raynaud’s disease, and epistaxis presented in her 38th week of pregnancy with 150 mL of bright-red hemoptysis. An isolated episode of small-volume hemoptysis occurred three months prior, at which time laryngoscopy revealed prominent anterior vessels in bilateral nares without active bleeding. Physical exam was unremarkable but CT-angiogram was notable for centrilobular consolidations and debris within the bronchus intermedius (Image 1). After interdisciplinary discussion between Interventional Pulmonology and Obstetrics, she underwent elective cesarean section due to concern that Valsalva during labor could precipitate hemoptysis. Bronchoscopy was performed on postpartum day three, revealing obstructive clots in the bronchus intermedius beyond which a focal area of pulsatile bleeding just beyond the right lower lobe-anterior basal segment was observed. Bronchial artery angiography demonstrated a tortuous, hypertrophic bronchial artery with active extravasation originating from the middle and inferior branches of the right bronchial artery. Together, the bronchoscopic and angiographic appearance was felt to be most consistent with a Dieulafoy lesion. Right bronchial artery embolization was performed, with immediate cessation of contrast extravasation, and repeat bronchoscopy confirmed resolution of bleeding. Hemoptysis did not recur, and she was referred for evaluation for hereditary hemorrhagic telangiectasia or autoimmune conditions as potential explanations for her prior bleeding events and vascular phenomena. Discussion The literature describing hemoptysis in pregnancy is limited to case reports and small series. The most common etiologies include infection, pulmonary embolism, and vascular anomalies 2,3. In this case, bleeding from the Dieulafoy lesion was likely precipitated by increased intravascular volume during pregnancy 1 . To our knowledge, a bronchial Dieulafoy lesion leading to hemoptysis in pregnancy has been reported once before1, and successful management with elective cesarean section of a term infant followed by postpartum bronchoscopy and bronchial artery embolization has not been previously described. Conclusion This unique case of hemoptysis secondary to a bronchial Dieulafoy lesion demonstrates how the physiologic changes of pregnancy can unmask pulmonary vascular abnormalities and provoke hemoptysis and highlights the importance of multidisciplinary management in the care of the pregnant patient. This abstract is funded by: None
Abraham et al. (Fri,) studied this question.